AB0760 EVOLUTION OF PATIENTS WITH GIANT CELL ARTERITIS: BEFORE AND AFTER THE BIOLOGICAL ERA
Authors: P. Vela Casasempere, L. Tudela, R. Caño-Alameda, S. Gomez-Sabater
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Giant cell arteritis (GCA) is the most common form of systemic vasculitis. The standard treatment to induce and maintain remission of GCA is based on the use of glucocorticoids (GC), often requiring high doses and for long periods of time. It has been associated with adverse events, sometimes severe, in up to 95% of cases (fractures, diabetes mellitus, hypertension, sepsis). In 2017, the first specific drug for this entity, tocilizumab (TCZ), an anti-IL-6 antibody, was approved. To date, there are few communications in clinical practice comparing the classical treatment scheme with the use of TCZ early. <h3>Objectives</h3> To compare patients treated with the standard regimen (corticosteroid monotherapy) versus those treated early with TCZ, in terms of the dose of corticosteroid received, use of immunosuppressants, and adverse events. <h3>Methods</h3> A retrospective observational study was carried out. Patients diagnosed with GCA in the Rheumatology section of the HGU Dr. Balmis during the period January 1, 2011, to November 1, 2021, were selected. Until 2017, patients received the standard regimen (corticosteroid monotherapy); from 2017, TCZ was associated early. Demographic data, treatment data (prednisone doses at months 1,3,6,12,18 and 24; use of immunosuppressants), and adverse events were collected. A descriptive analysis of the different variables was performed. The χ2 test or Fisher's exact test was used for the association between qualitative variables. For quantitative variables, mean comparison was performed using the t-student test. <h3>Results</h3> We obtained 73 patients (37% male and 63% female) with a mean age at diagnosis of 74.47 ± 8.4 years. All received initial corticosteroid treatment; 28 were also administered early TCZ (38.4%), the preferred route being subcutaneous (96.4%). The time between diagnosis and initiation of steroid treatment was a median of 0 days (median, IC 0-0), being 60 days for TCZ (IC 30-97). The use of immunosuppressants was higher in the glucocorticoid-only group than in the group treated with TCZ (57.8% vs. 21.4%, p=0.002). Prednisone dose was higher in the standard group at all follow-up time points (p&lt;0.001). No differences were found in the occurrence of adverse events, except infections, which were more frequent in the standard treatment group (standard 28.9% vs TCZ 3.6%, p=0.008). <h3>Conclusion</h3> Tocilizumab allows a greater and faster reduction of corticosteroids, compared to standard corticosteroid monotherapy, lower use of other immunosuppressants, and is associated with a lower frequency of infections. <h3>References</h3> [1]Palmowski A, Buttgereit F. Reducing the Toxicity of Long-Term Glucocorticoid Treatment in [2]Large Vessel Vasculitis. Curr Rheumatol Rep. 12 de octubre de 2020;22(12):85. [3]Hellmich B, Agueda A, Monti S, Buttgereit F, De Boysson H, Brouwer E, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2020;79(1):19-130. [4]Stone JH, Klearman M, Collinson N. Trial of tocilizumab in giant-cell arteritis. New Engl J Med 2017;377(15):1494-1495. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Paloma Vela Casasempere Speakers bureau: ROCHE, Grant/research support from: ROCHE, Lorena Tudela: None declared, Rocio Caño-Alameda: None declared, Silvia Gomez-Sabater: None declared.